Generating political priority for breastfeeding and the adoption of Kenya's 2012 BMS act: the importance of women's leadership.

Abstract

Background: The World Health Organization recommends initiating breastfeeding in the first hour of life, exclusive breastfeeding for six months, and continued breastfeeding for at least two years. Aggressive marketing of breast milk substitutes (BMS) undermines breastfeeding and is linked to adverse child and maternal health outcomes. This is particularly problematic in the Global South, where socioeconomic conditions often amplify the risks associated with BMS. The adoption of national BMS legislation in line with the 1981 International Code of Marketing of Breast-milk Substitutes is therefore crucial but difficult due to strong opposition from the transnational formula milk industry. Breastfeeding advocates in Kenya were able to overcome this powerful opposition when the country adopted a strict BMS Act in 2012, which has since facilitated and protected remarkable improvements in breastfeeding rates. We conduct a qualitative case study to identify the political enablers of the successful adoption of this important law.

Results: BMS legislation was first politically debated in Kenya in the 1980s following mobilization of women-led civil society organizations, namely the Breastfeeding Information Group and the Maendeleo ya Wanawake Organization. The issue re-emerged on the political agenda in the 2000s but faced opposition from the transnational formula milk industry. Kenya's BMS Act was ultimately adopted during a policy window opened by a constitutional reform. Support for the adoption of this landmark law was led by effective female political leaders, including public health minister Beth Mugo, the ministry's nutrition division head Terrie Wefwafwa, and members of the Kenya Women's Parliamentary Association. In the formulation and adoption of the law, these female leaders received important support from international organizations, such as the United Nations Children's Fund, as well as from powerful male allies, including president Mwai Kibaki.

Conclusions: The Kenyan case illustrates how women's political leadership can counteract the power of the transnational formula milk industry and help achieve strict BMS legislation. Effective female leadership for BMS legislation can occur in various political offices and positions, including those of ministers, legislators and bureaucrats. Female leaders can leverage their own influence by strategically exploiting policy windows and recruiting male allies.